Despite evidence that weight loss improves the severity of coronary heart disease (CHD) risk factors, a direct association between weight loss and CHD incidence has not been demonstrated. In ...1994–2001, the authors conducted an observational study of intentional weight loss as related to CHD incidence among patients recruited from a network of clinics in Israel who received nutritional counseling from a dietitian to support the medical recommendation to lose weight. Subjects were outpatients aged 50–75 years with a body mass index of ≥27 kg/m2, without CHD or cancer but with at least one risk factor for CHD in addition to overweight. Outcomes were documented over 4 years by repeated weight measurements and by medical record verification. Among 1,669 patients, 224 (13.4%) incidents of CHD were recorded. For subjects who underwent at least 6 months of dietetic counseling, the risk-factor-adjusted odds ratio for CHD incidence associated with a weight loss of 4.5 kg (the median level of weight loss) was 0.57 (95% confidence interval: 0.39, 0.84). In this, the largest known study of its type reported to date, intentional weight loss from a 6-month diet predicted lower incidence of CHD over 4 years.
Women with congenital long-QT syndrome experience an increased risk for cardiac events after the onset of adolescence that is more pronounced among carriers of the LQT2 genotype. We hypothesized that ...the hormonal changes associated with menopause may affect clinical risk in this population.
We used a repeated-events analysis to evaluate the risk for recurrent syncope during the menopause transition and postmenopausal periods (5 years before and after the age at onset of menopause, respectively) among 282 LQT1 (n=151) and LQT2 (n=131) women enrolled in the Long-QT Syndrome Registry. Multivariate analysis showed that the risk for recurrent syncope (n=150) among LQT2 women was significantly increased during both menopause transition (hazard ratio, 3.38; P=0.005) and the postmenopausal period (hazard ratio, 8.10; P<0.001) compared with the reproductive period. The risk increase was evident among women who did or did not receive estrogen therapy. In contrast, among LQT1 women, the onset of menopause was associated with a reduction in the risk for recurrent syncope (hazard ratio, 0.19; P=0.05; P=0.02 for genotype-by-menopause interaction). Only 22 women (8%) experienced aborted cardiac arrest or sudden cardiac death during follow-up. The frequency of aborted cardiac arrest/sudden cardiac death showed a similar genotype-specific association with the onset of menopause.
The onset of menopause is associated with a significant increase in the risk of cardiac events (dominated by recurrent episodes of syncope) in LQT2 women, suggesting that careful follow-up and continued long-term therapy are warranted in this population.
GUREVITZ, O., et al.: ST‐Segment Deviation Following Implantable Cardioverter Defibrillator Shocks: Incidence, Timing, and Clinical Significance. ST‐segment analysis is frequently used during ...surgical procedures, while ST deviation is considered a sign of myocardial injury. ST deviations were reported following transthoracic and epicardial electrical shocks. The prevalence, timing, and clinical significance of ST‐segment deviation following endocardial ICD shocks are discussed in this article. Twenty‐eight patients undergoing 125 shock episodes during ICD implantation or testing were included. A 12‐lead ECG was recorded at baseline, continuously during the first 3–10 seconds, 1 minute after test shocks, 3–10 seconds and 1 and 5 minutes after each shock given to terminate VF. ST deviation was diagnosed when the ST‐segment was displaced ≥ 1 mm in at least one lead compared to baseline. ST‐segment deviations were observed after 49 (39%) of all shock episodes in 17 (61%) of patients. ST elevation was observed after 30 (24%) of all shock episodes, and ST depression after 31 (25%). Following 13 shock episodes in seven patients, ST‐elevation and depression were observed. ST depressions occurred more frequently after shocks given to terminate VF than after lower energy test shocks (28% vs 18% respectively, P = 0.045). However, there was no significant difference in the prevalence of ST elevations between the lower or higher energy shocks. No adverse clinical events were observed in patients with or without postshock ST‐segment deviation. ST‐segment deviation following endocardial ICD shocks is a frequent phenomenon, occurring acutely and resolving during the first few minutes postshock. It may have no prognostic implications.
Purpose
Response to cardiac resynchronization therapy (CRT) is well-established in patients with typical left bundle branch block (LBBB) but modest or even negative in those with intraventricular ...conduction delay (IVCD). However, IVCD pattern is heterogeneous, and it is possible that QRS patterns may also respond to CRT.
Methods
Consecutive baseline ECGs of 239 patients implanted between 2007 and 2010 with CRT were analyzed. ECGs were classified into the following three groups: (a) typical LBBB (TLBBB) according to accepted guidelines (
n
= 67); (b) IVCD with LBBB pattern criteria in V1, 1, and aVL but with QS or rS in V5–V6 which we defined as atypical LBBB (ALBBB) (
n
= 74); and (c) all other IVCD (OIVCD) patterns (
n
= 98). Endpoints were 2 years mortality and echocardiographic response, defined as a decrease of ≥ 10% in indexed LVESV or an increase of ≥ 5% in left ventricular ejection fraction at 1 year of follow-up.
Results
Baseline clinical characteristics were similar among all the three groups. Rates of echocardiographic response were lower among those with OIVCD compared to those with LBBB and ALBBB (50% vs. 75% and 72%, respectively,
p
= 0.01 for both comparisons). A multivariable model showed a lower likelihood of echocardiographic response in OIVCD HR = 0.40; (0.16–0.98) and a similar likelihood in ALBBBB HR = 0.98; (0.40–2.40) compared to TLBBB. Cumulative 2-year survival was 88% in ALBBB, 86% in TLBBB, and 76% in OIVCD (
p
value = 0.011).
Conclusion
Patients with ALBBB may have a favorable echocardiographic response to CRT and display similar survival rates to typical LBBB. This subgroup of IVCD should be considered for CRT.
Condensed abstract
Atypical left bundle branch morphology defined as QS or rS in lead V1, broad R waves in lead I, and aVL but with QS or rS in V5–V6 is associated with favorable echocardiographic response to CRT and displays similar survival rates to typical LBBB patients.
In idiopathic dilated cardiomyopathy, echocardiographic recordings of the proximal flow convergence region during mitral regurgitation (MR) have demonstrated a distinct biphasic pattern of flow and ...orifice area variation--a decrease during left ventricular contraction, an increase during ventricular relaxation. Schwammenthal et al hypothesized that the pattern of regurgitant orifice area variation in ischemic MR due to inferoposterior wall motion abnormalities will be similar, because the observed geometric substrate of regurgitation--apical tenting of the mitral valve--suggests a similar mechanism.
Strategically chosen ventricular tachycardia (VT)/ventricular fibrillation (VF) detection and therapy parameters aimed at reducing shock deliveries were proven effective in studies that utilized ...single manufacturer devices with a follow-up of up to 1 year. Whether these beneficiary effects can be generalized to additional manufacturers and be maintained for longer periods is to be determined. Our aim was to evaluate the durability and applicability of the programming of strategic implantable cardioverter-defibrillators (ICDs) of various manufacturers, which is aimed at reducing the shock delivery burden in primary prevention ICD recipients.
A retrospective analysis of prospectively collected data of 300 ICD recipients of various manufacturers was conducted; 160 devices were strategically programmed to reduce shocks and 140 were not. The primary endpoint was the composite of death and appropriate shocks. Additional outcomes were inappropriate shocks, syncope events, and non-sustained VTs. At a median follow-up of 24 months, 19 patients died, 31 received appropriate shocks, and 41 received inappropriate shocks. Multivariate analysis showed that strategic programming dedicated to shock reduction was associated with a 64% risk reduction in the primary endpoint hazard ratio (HR): 0.13-0.93; P = 0.03 and a 70% reduction in inappropriate shock deliveries (HR: 0.16-0.72; P = 0.01). Very few syncope events occurred (five patients, 1.6%), and there was no between-group difference in this outcome.
Utilization of strategically chosen VT/VF detection and therapy parameters was found to be effective and safe in ICDs of various manufacturers at a median follow-up period of 2 years among primary prevention patients.
Conclusions Long-term follow up results of strategically chosen VT detection and therapy parameters show consistent efficacy in reducing shock deliveries, as well excellent safety profile for a ...primary prevention patient population.
Invagination is an innovative technique for closing the left atrial appendage (LAA) to reduce the risk of thrombi formation. The influence of LAA invagination on the flow fields in the atria was ...investigated based on a computational fluid dynamics. The simulation results demonstrated that the novel invagination process can eliminate low velocities (blood stasis) and low shear rate and thus decrease the risk of thrombus formation during atrial fibrillation. This innovative technique may enhance the clinical treatment of patients with atrial fibrillation by improving the atrial flow field while lowering the risk of creating emboli.
Transvenous lead extraction can lead to tricuspid valve damage.
To assess the incidence, risk factors and clinical outcome of tricuspid regurgitation (TR) following lead extraction.
We prospectively ...collected data on patients who underwent lead extraction at the Sheba Medical Center prior to laser use (i.e., before 2012). Echocardiography results before and following the procedure were used to confirm TR worsening, defined as an echocardiographic increase of at least one TR grade. Various clinical and echocardiographic parameters were analyzed as risk factors for TR. Clinical and echocardiographic follow-up was conducted to assess the clinical significance outcome of extraction-induced TR.
Of 152 patients who underwent lead extraction without laser before 2012, 86 (56%) (192 electrodes) had echocardiography results before and within one week following the procedure. New or worsening TR was discovered in 13 patients (15%). Use of mechanical tools and younger age at extraction were found on multivariate analysis to be factors for TR development (P = 0.04 and P = 0.03 respectively). Average follow-up was 22.25 ± 21.34 months (range 8-93). There were no significant differences in the incidence of right-sided heart failure (50% vs. 23%, P = 0.192) or hospitalizations due to heart failure exacerbations (37.5% vs. 11%, P = 0.110). No patient required tricuspid valve repair or replacement. Death rates were similar in the TR and non-TR groups (20% vs. 33%).
TR following lead extraction is not uncommon but does not seem to affect survival or outcomes such as need for valve surgery. Its long-term effects remain to be determined.
Background
Contemporary implantable cardiac defibrillators (ICD) enable storage of multiple, preepisode R‐R recordings in patients who suffered from ventricular tachyarrhythmia (VTA). Timely ...prediction of VTA, using heart rate variability (HRV) analysis techniques, may facilitate the implementation of preventive and therapeutic strategies.
Aim
To evaluate the novel multipole method of the HRV analysis in prediction of imminent VTAs in ICD patients.
Methods
We screened patients from the Biotronik HAWAI Registry (Heart Rate Analysis with Automated ICDs). A total of 28 patients from the HAWAI registries (phase I and II), having medical records, who had experienced documented, verified VTA during the 2‐year follow‐up, were included in our analysis. HRV during preepisode recordings of 4,500 R‐R intervals were analyzed using the Dyx parameter and compared to HRV of similar length recordings from the same patients that were not followed by arrhythmia.
Results
Our study population consisted mainly of men 25 of 28 (89%), average age of 64.8 ± 9.4 years, 92% with coronary artery disease. HRV during 64 preevent recordings (2.3 events per patient on average) was analyzed and compared with 60 control recordings. The multipole method of HRV analysis showed 50% sensitivity and 91.6% specificity for prediction of ventricular tachycardia/ventricular fibrillation in the study population, with 84.5% positive predictive value. No statistically significant correlation was found between various clinical parameters and the sensitivity of imminent VTA predetection in our patients.
Conclusion
The multipole method of HRV analysis emerges as a highly specific, possible predictor of imminent VTA, providing an early warning allowing to prepare for an arrhythmic episode.
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